RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.
PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. Name of the Candidate and address: Ms. NEELAM SHARMA 1ST YEAR M.Sc. NURSING, ANURADHA COLLEGE OF NURSING SRIGANDADAKAVAL, VISHWANEEDAM POST, BANGALORE-560 091.
2. Name of the Institution: ANURADHA COLLEGE OF NURSING SRIGANDADAKAVAL, HEGGANAHALLI CROSS, VISHWANEEDAM POST BANGALORE-560 091.
3. Course of Study and Subject: M.Sc. NURSING COMMUNITY HEALTH NURSING
4. Date of Admission to the Course: 15-05-2009
5. Title of the topic:
“A STUDY OF ASSESS THE KNOWLEDGE & ATTITUDE AMONG SCHOOL CHILDREN REGARDING DENGUE FEVER AT SELECTED SCHOOL OF BANGALORE, WITH A VIEW TO DEVELOP A SELF INSTRUCTION MODULE”.
6. BRIEF RESUME OF THE INTENDED WORK:
1 6.1 Need for Study:
Dengue is a rapidly growing public health problem in tropical & subtropical countries where the majority of the world’s population resides and is increasing most rapidly.
However, most of these nations are economically disadvantaged & are faced with multiple public Health problems, & therefore may not have the resources to combat the continued emergence of Dengue1.
Dengue fever is the commonest of the arboviral infection in humans. The global incidence of Dengue fever, Dengue hemorrhagic fever has increased dramatically in recent decades.
The study focuses on to assess the knowledge and attitude of 6 – 12 years of children regarding Dengue fever2.
Dengue fever is an infectious disease, which is characterized by severe pain in eyes, head and extremities. It is transmitted by the bite of a mosquito3.
The worldwide incidence is estimated to be 50 to 100 million cases of Dengue fever & over 5, 00,000 cases of Dengue Hemorrhagic fever per year4.
With approximately two billon people living in tropical & subtropical regions of the world, & on additional roughly 120 million people each year travelling to these regions, a large share of the world’s population is at risk of contracting Dengue. Two estimates have suggested that between 50 & 100 million cases of Dengue fever occur annually, corresponding to an incidence rate of 2.5 – 5.0% of the two billion people worldwide at risk.
2 These cases result in hundred of thousand of hospitalization & about 20,000 deaths each year5.
Due to unhygienic practice and no vaccine available to prevent Dengue fever. Due to lack of knowledge about personal protection such as full coverage clothing, mosquito net, mosquito coils & Traveling during periods of minimal mosquito activity6.
A study was conducted on Dengue fever in Travelers to the Tropics. They concluded
114 patients were identified seven patients were excluded from the study, because of incorrect or missing data that prevented us from confirming age & sex. Then the result shows most cases (95 & 107) were investigated at department of infections disease 107 patients who received a questionnaire. 75 responded Dengue fever was diagnosed in 59 responders. Of the
74 responders, 40 were women & 34 men, compared with 13 women & 20 men among the non-responders. The responders were of similar age, as the non-responders. Age distribution did not differ between the different countries of infection7.
A study was conducted on a case of invasive aspergillosis, associated with complete heart block & heart failure in an immuno competent child recovering from Dengue shock syndrome. A 9 years old boy was admitted with Dengue shock syndrome. During the recovery phase, the child developed reoccurrence of fever & signs of congestive heart failure.
Thereafter, he developed complete heart block & died. A renal biopsy specimen also showed glomerular invasion with aspergillus patchy necrosis. This suggested the diagnosis of invasive aspergillosis8.
3 A study was conducted on Dengue recent advances in biology and current status of translational research. Dengue is a very rapidly growing public health problem being currently faced by approximately 40% of the global population living in more than a hundred tropical & subtropical countries. It is a viral disease, caused by four types of Dengue viruses, transmitted by mosquitoes, to an estimated 50 million people each year vector control methods to contain transmission have not been successful and there is currently no useful diagnostic test, drug or vaccine to combat Dengue disease. This has resulted in novel insights into several aspects of Dengue virus biology & identified potential drug target. Several tetravalent vaccines are being developed9.
80% at Indian population lives in rural areas they have inadequate knowledge about the prevention. School children and their parents were unaware of the life threatening complication proceeding Dengue fever. Despite research in this area, there is still so much to be learned about life style modification & adequate knowledge regarding prevention of
Dengue fever.
The school children were not aware of the complications of Dengue fever. Hence the investigator felt a need to assess the knowledge & attitude among school children regarding
Dengue fever & prepare self-instructional module based on their learning needs.
4 6.2 Review of Literature:
Review of literature is to ascertain what is already known in relation to problem of interest, to develop, a broad conceptual context into which, a problem will fit. It helps to know methodology & research tools, especially, research strategies & specific procedures, measuring instruments & statistical analysis that might be productive in pursuing the research problem a interpreting the result of study10.
A study was conducted on seropositive cases of Dengue less than 12 years of age admitted in a tertiary level referral Centre during the outbreak of Dengue in Chennai India.
Fifty nine were admitted during the study period & detailed clinical history, physical examination & laboratory values were recorded on presentation. The cases were followed up daily for clinical & laboratory parameters. These results showed that children with Dengue who present with drowsiness, retro-orbital pain, positive tourniquets test, platelet counts below 50,000/cumm & a fall haematocrit on therapy by more than 20% & these who do not have body pain should be monitored very carefully, as they are more prone to develop complications11.
A study was conducted on an outbreak of Dengue fever in Peri urban slum of
Chandigarh, India with a reference to entomological and climatic factors. They have taken blood samples from 218 patients and 30 apparently healthy contacts were tested for Dengue specific. IgM and IgG antibodies including 80 acute samples collected with in 5 days of illness were subjected for virus isolation in newborn mice. A total of 76 cases were
5 positive by either Dengue IgM capture assay (n=57) or virus isolation (n=17) or both (n=2).
15 –19 viral isolates subjected for typing by type-specific multiplex reverse transcription- polymerase chain reaction were found to be of Dengue virus12.
A study was conducted on transfusion support to Dengue patients in a hospital based blood transfusion service in north India. They evaluated transfusion requirements in a retrospective study of 245 patients with various categories of Dengue infection. The majority
(155/245) of our patients were of the Dengue fever category. There was no correction between clinical bleed and platelet count as 81 non bleeding patients were having counts (20 x 10 (3) micro lt. Coagulopathy was observed in 37% of the patients with Dengue hemorrhagic lever or Dengue shock syndrome. A rapid response to platelet and fresh frozen plasma (FFP) transfusion was observed in all cases13.
A pilot study was conducted on early differentiation between Dengue and septic shock by comparison of admission homodynamic, clinical and laboratory variables. They have selected 32 patients {16 Dengue shock syndrome (DSS) and 16 septic shock (SS) patients with septic shock were more likely to require greater than 40ml/kg of fluid for initial resuscitation, ventilation and vasoactive support for shock compared with those with Dengue.
In the fluid and catecholamine refractory patients, 6 of 16 shock syndrome versus 0 of 16
Dengue shock syndrome patients were treated with steroids. The outcome was similar in both groups, with 2 of 16 deaths …..
6 among children with shock syndrome and 1 of 16 in those with Dengue shock syndrome14.
A study was conducted on Dengue hemorrhagic fever; knowledge attitude and practice in Ang Thong province, Thailand. They were collected serum samples from 90 admitted children and also from 80 healthy students. The Dengue cases were classified as Dengue fever (9 cases 12.2%) and Dengue shock syndrome (65 cases 87.8%) 9 patients had Dengue shock syndrome, but no death occured. Dengue hemorrhagic fever knowledge of the caretaker of the Dengue cases, non-cases recognized. They had a higher response in prevention, control and treatment of Dengue hemorrhagic fever than the other two groups after their children were admitted to hospital. The results indicated that Dengue hemorrhagic fever remains a public health problem in this area and the people need more understanding of the disease15.
A study was conducted on multi model, Aedes aegypti mosquito reduction interventions and Dengue fever prevention. Intervention effectiveness was assessed using mulla’s formula to determine percent reduction for all studies with control groups. 21 studies were reviewed.
Eight studies involved the use of biological method. Finally eight studies used chemical control and three studies using a combination of intervention techniques. They suggested that conclusion little evidence exists to support the efficacy of mosquito abatement programs owing to poor study designs and lack of congruent entomologic indices16.
7 A study was conducted on a successful management of Dengue fever in pregnancy
(New Delhi) They encountered at least seven cases of fever with thrombocytopenia in pregnancy but only two were seropositive for Dengue. In one of the cases there was PPH while in other case there was perinatal transmission to the neonate requiring platelet transmission17.
A study was conducted on retinal hemorrhages in 4 patients with Dengue fever. They suggested that clinical diagnosis of Dengue fever was confirmed by PER in 2 cases, by IgG and IgM in 1 patient, and by IgM in the remaining patient. Dengue virus was isolated from all 4 patients. All were serotype l. In 3 patients, visual symptoms resolved completely with in
2 days. Improvement in visual symptoms was delayed and incomplete in patient 4, and she had reduced visual acuity and metamorphosia even after 2 months18.
A study was conducted on intracranial hemorrhage in Dengue fever management and outcome. They discussed the management of 5 uncommon cases of intracranial hemorrhage in Dengue. Result showed that two patients who underwent surgery had excellent outcome.
One patient was managed conservatively with cerebral decongestants. Two patients with deep-seated bleed had very deterioration and died19. 6.3 STATEMENT OF THE PROBLEM:
A STUDY TO ASSESS THE KNOWLEDGE & ATTITUDE AMONG SCHOOL
CHILDREN REGARDING DENGUE FEVER AT SELECTED SCHOOL OF BANGALORE,
WITH A VIEW TO DEVELOP A SELF INSTRUCTION MODULE.
8 6.4 OBJECTIVES OF THE STUDY:
1. To assess the knowledge regarding Dengue fever among school children.
2. To assess the attitude regarding Dengue fever among school children.
3. To compare the knowledge & attitude regarding Dengue fever among school
children.
4. To find out the association between knowledge of Dengue fever among school
children and with selected demographic variables such as age, sex, education of
child, Education of parents, place, occupation of the parents.
5. To find out association between attitude of Dengue fever among school children and
with selected demographic variables such as age, sex, education of child, Education
of parents, place, occupation of the parents.
6. To develop the self-instructional module on Dengue fever for school children.
9 6.5 HYPOTHESIS:
H1 There will be significant correlation between the knowledge and attitude regarding
Dengue fever among school children.
H2 There will be significant association between the knowledge regarding Dengue fever
and with selected Demographic variables. Age, Sex, Education of Child, Education of
Parents, Place, Occupation of the Parents.
H3 There will be significant association between the attitude regarding Dengue fever
and with selected Demographic variables. Age, Sex, Education of Child, Education of
parents, Place, Occupation of the Parents. 6.6 OPERATIONAL DEFINITIONS:
School Age children: Age group between 06-12 Years.
Dengue Fever: Dengue fever is an infectious disease, which is characterized by
severe pain in eyes, head & extremities. It is transmitted by the bite of a mosquito.
Knowledge: The level of under standing of school children regarding Dengue Fever
to range of information awareness or all that has been perceived or grouped by the
school children.
Attitude: The way of thinking or behaving of school children regarding Dengue
Fever.
10 6.7 ASSUMPTIONS:
The study is based on following assumptions.
Children have good knowledge regarding Dengue fever.
They have positive attitude regarding Dengue fever.
To prevent Dengue Fever, use personal protection such as full coverage clothing,
netting, mosquito coils and clean house surroundings and if possible travel during
periods of minimal mosquito activity. 6.8 DELIMITATION:
1. The study is delimited to 6-12 yrs
2. The period of the study is 4-6 weeks 6.9 PROJECTED OUTCOME:
- The present study will help to improve the knowledge of school children
regarding Dengue fever.
- The study will help to develop a positive attitude among school children regarding Dengue
Fever.
- The study will help to know about the prevention of Dengue fever. Using personal
protection such as full coverage netting, mosquito repellent containing DEET and clean
house surroundings. 7. MATERIAL AND METHODS OF THE STUDY;
7.1 SOURCE OF DATA:
The data will be collected from the school children who are studying in the selected school of
Bangalore. 7.1.1 RESEARCH DESIGN:
A descriptive design will be used for the study 7.1.2 RESEARCH APPROACH:
Survey Approach
11 7.1.3 SETTING OF THE STUDY:
The study will be conducted in the Indian Public High School Manjunathnagar Bangalore-
10. 7.1.4 POPULATION:
The accessible population for present study is the school children who are studying at schools
of Bangalore. 7.1.5 SAMPLE:
A sample consists of subject of units that comprises the population for present study sample
size is 100 children 7.1.6 SAMPLING TECHNIQUE:
The purposive sampling technique will be used to select the subjects. 7.2 CRITERIA FOR SAMPLE SELECTION:
7.2.1 INCLUSIVE CRITERIA:
The study includes the school children who are:
Age group between 6 – 12 years.
Present at the time of data collection at selected school.
Willing to participate in study.
Able to understand English and Kannada 7.2.2 EXCLUSIVE CRITERIA:
The study excludes the school children who are:
Age group above 12 years
Those who are sick
12 7.2.3 METHODS OF DATA COLLECTION:
DATA COLLECTION INSTRUMENT:
The investigator planned to assess the knowledge and attitude of school children through
structured interview schedule and questionnaires, It consists of 3 sections.
Section I – deals with Demographic data.
Section II – Structured interview schedule will be used to assess the knowledge regarding
Dengue fever among school children.
Section III – Questionnaires will be used to assess the attitude regarding Dengue fever
among school children. 7.2.4 DATA COLLECTION METHOD:
Prior permission will be obtained by the significant authorities and from the subjects. The
investigator will use structured interview schedule and questionnaires to assess the
knowledge and attitude regarding dengue fever from school children. Interview will be
conducted between 9 am to 2 pm depending upon the availability of sample. The duration of
the study will be 4 weeks. The duration of 30 minutes will be spent per each subject.
7.2.5 PLAN FOR DATA ANALYSIS:
Descriptive statistics like mean standard deviation and frequency distribution and inferential
statistical like chi-square test will be used to analyze the collected data. 7.2.6 PILOT STUDY:
10 samples will be selected and study will be conducted to find out the feasibility. 7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO
BE COLLECTED ON PATIENTS OR OTHER HUMAN OR ANIMALS?
Yes
13 7.4 HAS THE ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR
INSTITUTION IN CASE OF 7.3?
Yes
Permission will be obtained from the research committee of Anuradha College of Nursing
and also permission will be obtained from the head of School. Before collecting the data
permission will be obtained from the study subjects.
14 8. LIST OF REFERENCES:
1. Jose A Suaya, Donald S Shepard, Mark E Beatty (2007) Dengue ‘Burden of Disease
and causes of illness” Source WHO/TDR.
2. M Narayanan, MA Aravind, , P.Ambika Pathy, R Prema and MP Jeya Paul (2003)
Dengue Fever – Clinical and Laboratory parameters Associated with complication
Vol.27
3. Sally wehmeier, colin Mclntosh, Joana Turnbull, Michael Ashby. “oxford Advanced
Learner’s Dictionary.” 7th edition: 407.
4. Malstead SB, Dengue fever in: Cohen J, Powderly WG, Berkely SF, Calandra T,
Clumeck N, Finch RG(2005) Principles and Practice of Infectious Diseases 6th
Edition.
5. Jose A Suaya, Donald S Shepard, Mark E Beatty (2007) Dengue ‘Burden of Disease
and causes of illness” Source WHO/TDR.
6. Malstead SB, Dengue fever in: Cohen J, Powderly WG, Berkely SF, Calandra T,
Clumeck N, Finch RG(2005) Principles and Practice of Infectious Diseases 6th
Edition.
7. Heidi Lindback, Johan Lindback, Anders Tegnell, Ragnhild Janzon, Sirkka vene and
Karl Ekdahl (1998 & 1999), Dengue Fever in Travelers to the Tropic.
8. Kohili U, Sahu T, Lodha R, Agarwal N, Ray Rm (2007) Pediatric Crit, Care Med
(389-391)
9. Swaminathans, Khanna N, (2009) current Mol. Med (151-173)
10. National Research center on Equines, Annual Report 2002-2003 in Karnataka.
15 11. M Narayanan, MA Aravind, , P.Ambika Pathy, R Prema and MP Jeya Paul (2003)
Dengue Fever – Clinical and Laboratory parameters Associated with complication
vol. 27.
12. R K Ratho , B Mishara, J Kaur, N Kakkar, K. Sharma (2005) original Article Vol. 59
(519-527)
13. Chaudhary R, Ketan D, Sinha S, Sinha P, Sonker A, Pandey P, Dos SS, Agarwal P,
Ray V(2006) Transfusion Apher Sci (239-244)
14. Ranjit, Kissan N, Gandhi D, Dayal A, Rajeshwari N, Kamath S R (2007), Pediatric
Emerg Care (368 – 375)
15. Kittigul L, Suankeowk, Sujirarat D, Yoksana (2003) Southeast Asian J Trop Med
Public health (385-392)
16. Ballenger- Browning KK , Elder JP (2009) Trop Med Int Health.
17. N Singh, KA Sharma, V Dadhwal, S Mittal, A Selvi, (2008) A successful case Report
Management of Dengue Fever in pregnancy (377-380)
18. In (2004) A case study on Retinal Hemorrhages in 4 particants with Dengue fever.
19. Kumar R, Prakash O, Sharma BS (2009), Surg Neural (429-433)
16 9. Name & Signature of Candidate Neelam Sharma
10. Remarks of the Guide The study is suitable & feasible 1. Name & Designation of Guide Devi Priya
Signature of Guide
2. Co-Guide
Signature of Co-Guide
3. Head of the Department Devi Priya
Signature of HOD
4. Remarks of the Principal: The study is suitable & feasible
Name & Signature of Principal Radhika .K
17